Provider Demographics
NPI:1164740031
Name:CANUSO, DANA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:CANUSO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 HAZELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4706
Mailing Address - Country:US
Mailing Address - Phone:609-744-6931
Mailing Address - Fax:
Practice Address - Street 1:406 HAZELWOOD LN
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4706
Practice Address - Country:US
Practice Address - Phone:609-744-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00304100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MD00304100OtherNJ LICENSE